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Category: Volume 06 Issue 06 June 2018
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Title: Management of Pertrochanteric Fractures in Elderly High-Risk Patients with an External Fixation

Authors: Hilal Ahmad Kotwal, Raja Rameez Farooqi, Mir Samiullah

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i6.06

Abstract

Background: Pertrochanteric femur fractures are common in older people. In high-risk patients, especially American

Society of Anesthesiologists (ASA) scores 3 and 4, surgery with internal fixation can cause excessive stresses. Fixation of these fractures using multiple Schanz screws (External Fixator) under local anaesthesia without exposure offer adequate stability permitting early ambulation with least risk from medical problems. Therefore, external fixation is a viable option for treating these high risk patients.

Objective: The aim of this study was to analyze the results and complications of external fixation of “pertrochanteric” fractures in high-risk geriatric patients with high unacceptable operative risk to withstand conventional osteosynthesis.

Materials and Methods: In 60 surgical high-risk patients (ASA grade 3 or 4) pertrochanteric fractures admitted in our hospital (January  2014-November 2015),  were  treated  with  an  external  fixation  performed  under  local anesthesia. There were 26 men and 34 women. Mean age was 76.09 (70–91) years. Epidemiological and radiological data and also complications were recorded at each follow-up and final follow up was done at one year.

Results: The average operative time (and SD) was 32.22 ± 5.9 minutes. Hospital stay was short, with an average of 4.2 ± 1.04 days, thus reducing the total cost. No intraoperative complications were encountered. Blood loss was negligible and none of the patients received any blood transfusion. All fractures healed within 18 weeks. The mean time for union was 12.5 ± 1.24 weeks. Complications encountered were superficial pin-tract infection in 18 patients (30%) and deep pin-tract infection in three patients (5%). In

25 (41.66%) patients the fracture united with a shortening of 15 mm or more. Four patients (6.66%) had implant failure (2 pin migration and 2 pin cut-out) and were treated by revision fixation without any complication. Limitation of knee movements were recorded in only two (4%) patients at 12 months. The lower extremity measure score based on daily activities, walking capacity and pain showed no significant difference between the preinjury and the final functional score at 12 months (p > 0.05).

Conclusion: External fixation of pertrochanteric fractures is an effective, safe and reliable treatment method. It offers minimal operative and anaesthetic risk, no blood loss, short hospital stay, early mobilization and low morbidity and mortality.

Keywords:  elderly, external fixation, pertrochanteric fracture, local anesthesia, high-risk, osteoporosis.

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Corresponding Author

Hilal Ahmad Kotwal

PG Dept of Orthopedics, GMC Srinagar, J&K India